tbuckley/cabot-search huggingface dataset:
Abstract MP77: Perceived Stress From Childhood to Young Adulthood and Cardiometabolic Endpoints in Young Adulthood: A Longitudinal Study of the Southern California Children’s Health Study
Authors: Fangqi Guo, Xinci Chen, Phoebe Danza, Zhongzheng Niu, Yanjie Li, Howard N Hodis, Carrie V Breton, Theresa Bastain, Shohreh F Farzan
Journal: Circulation (2023)

The longitudinal impact of perceived stress on the risk of cardiometabolic disease has not been comprehensively evaluated among children and young adults. We hypothesized that patterns of perceived stress from childhood to adulthood may predict cardiometabolic risk in early adulthood. As part of the Southern California Children’s Health Study (CHS), we examined perceived stress score (PSS) in adolescence (mean age, 13.3 years) and young adulthood (mean age, 23.6 years) among 276 participants. Based on PSS in adolescence and young adulthood, participants were categorized into 4 stress pattern groups: consistently high (n = 85), decreasing (n = 49), increasing (n = 59), and consistently low (n = 65). CHS participants were assessed for seven measures of cardiometabolic disease risk, namely carotid artery intima-media thickness (CIMT), systolic and diastolic blood pressure (SBP and DBP), obesity, percent body fat, android/gynoid ratio, and elevated HbA1c in their young adulthood. An overall cardiometabolic risk score was generated by summing the number of clinically elevated measures to indicate cumulative cardiometabolic risk. Using multivariate linear and logistic regression models, we examined PSS measured at single time points and change in PSS score across adolescence to young adulthood in relation to cardiometabolic disease risk. Results indicated that PSS in adulthood had significant positive associations with overall cardiometabolic risk score (Beta, 0.12: 95% CI, 0.01-0.22; p =0.031), CIMT (Beta, 0.01; 95% CI, 0.00-0.02; p =0.043), SBP (Beta, 1.27, 95% CI, 0.09-2.45; p =0.035), and DBP (Beta, 0.94; 95% CI, 0.13-1.76; p =0.024). Further, analyses of PSS patterns suggested that individuals with consistently high PSS had higher cardiometabolic risk scores (Beta, 0.26; 95% CI, -0.02-0.54; p =0.066), as well as significantly higher android/gynoid ratio (Beta, 0.09; 95% CI, 0.03-0.14; p =0.002), percent body fat (Beta, 0.96; 95% CI, 0.51-5.41; p =0.018), and greater odds of obesity (OR, 5.73; 95% CI, 1.96-16.78; p = 0.001), compared to individuals with consistently low PSS. Our work suggests that perceived stress from adolescence to adulthood may contribute to cardiometabolic disease risk in adulthood. Interventions to reduce stress earlier in life (e.g., in adolescence) should be investigated for their potential to reduce cardiometabolic disease risk factors in young adulthood.
Abstract P100: Associations Between Urinary Biomarkers at Baseline and Salt and Potassium Sensitivity: The GenSalt Study
Authors: Kieran J Maroney, Hua He, Yadan Li, Jiang He, Jing Chen
Journal: Circulation (2023)

Introduction: Salt sensitivity of blood pressure is associated with an increased risk of hypertension and cardiovascular disease. Measurement methods of salt sensitivity of BP are inconvenient thus identifying biomarkers for salt sensitivity of BP has important clinical significance. Hypothesis: The urinary excretion of dopamine, kallikrein, norepinephrine and uromodulin at baseline are associated with salt sensitivity of BP. Methods: The Genetic Epidemiology Network of Salt Sensitivity (GenSalt) (n=1887) and GenSalt Replication (n=690) studies dietary interventions included a 3-day baseline exam, 7-day low sodium feeding, a 7-day high sodium feeding, and a 7-day high sodium feeding with potassium supplementation. Baseline urinary dopamine, kallikrein, norepinephrine, and uromodulin were measured by ELISA methods. Salt and potassium sensitivity were defined as change in SBP and DBP during dietary intervention. Urinary biomarkers below limit of detection (LOD) were replaced using LOD/√2 and censored likelihood multiple imputation (CLMI). Linear models between standardized log transformed urinary biomarkers and change in SBP and DBP were assessed after adjustment for age, baseline BP, sex, education, physical activity, smoking status, alcohol intake, 24-hour sodium excretion and GenSalt cohort. Results: Norepinephrine was positively associated with SBP in CLMI models (0.10 mmHg, CI: 0.00, 0.19) and DBP in LOD/√2 models (0.31 mmHg, CI: 0.05, 0.57) and CLMI models (0.10 mmHg, CI: 0.02, 0.18) during high sodium diet. Uromodulin was associated with decreased SBP in LOD/√2 models (-0.36 mmHg, CI: -0.57, -0.14) and CLMI models (-0.19 mmHg, CI: -0.31, -0.08) during potassium supplementation. Similarly, dopamine was positively associated with DBP during high sodium diet and negatively associated with DBP during potassium supplementation. Conclusion: These data indicate urinary biomarkers dopamine, norepinephrine and uromodulin are associated with BP salt sensitivity and may be used in risk stratification.
Abstract P330: Effect of Randomized Omega-3 Treatment on Downstream Bioactive Lipids and Their Association With Incident Cardiovascular Disease Events: Metabolomic Studies of the Vital and Jupiter Trials
Authors: Olga Demler, Yanyan Liu, Mona Alotaibi, Rosangela Hoshi, Franco Giulianini, Heike Gibson, Jeramie Watrous, Nancy R Cook, Karen Costenbader, Olivia Okereke, Robert Glynn, Paul M Ridker, Joann E Manson, Susan Cheng, Daniel Chasman, Mohit Jain, Samia Mora
Journal: Circulation (2023)

Background: The effect of omega-3 (n-3) treatment on cardiovascular disease (CVD) outcomes in randomized controlled trials remains inconsistent. We hypothesize that the downstream products of n-3 metabolism, including bioactive lipids (BALs), have a heterogeneous relationship with CVD, which may provide insight into response heterogeneity. Methods: Using state of the art LC-MS, we assayed the plasma bioactive lipidome (&gt;10K BALs) across 3,512 individuals at baseline and Y1 or -2, in the VITAL substudies (CVD case control N=1540; CTSC subcohort N=1054; 45% women, median age 70, 20% non-white) and JUPITER CVD case control (N=918) (NCT01169259, NCT00239681). Linear regression revealed BALs that change consistently with n-3 treatment (n3BALs) (discovery in VITAL controls, validation in an independent VITAL CTSC substudy, cumulative FDR .05). n3BALs that are also associated with CVD in VITAL CVD were identified using adjusted conditional logistic regression (p&lt;.05). A BAL score was established using a multivariable adjusted model and validated externally in JUPITER CVD. Y1 or -2 change in BAL score in response to randomized n-3 and nonrandomized fish intake were tested using 2-sample t-test (p&lt;.05). Results: 354 BALs changed in response to randomized n-3 vs placebo. Baseline levels of 8 of these BALs were significantly associated with incident CVD (Figure, panels A, B). When combined into the multivariable BAL score, 5 were inversely and 3 positively associated with the CVD risk. The BAL score was significantly associated with CVD with fully adjusted HR/SD of 1.32, 95%CI [1.12 - 1.55] in external study, Figure panel C. N-3 therapy, statin therapy and baseline fish intake were associated with weak Y1 or -2 reduction in BAL score. Conclusions: Downstream BALs are altered in response to n-3 treatment and associate with both decreased as well as increased risk of CVD. BAL response to n-3 treatment may explain clinical heterogeneity associated with fish oil supplementation and may be utilized for selection of more specific treatment.
Abstract P209: Late-Life Dietary Intake and Risk of All-Cause Mortality in the Atherosclerosis Risk in Communities Study (ARIC) Study
Authors: Shutong Du, Nikolaos Rivera, Lyn Steffen, Josef Coresh, Casey M Rebholz
Journal: Circulation (2023)

Introduction: Older populations have been growing dramatically worldwide. Aging may lead to changes in diet quality. There is a need to better understand dietary intake during late-life and the impact on health outcomes. Hypothesis: We hypothesized that adherence to healthy dietary patterns, i.e., the Dietary Approaches to Stop Hypertension (DASH) and the alternate Mediterranean (aMED) diets, would be associated with lower risk of all-cause mortality. Methods: Atherosclerosis Risk in Communities (ARIC) study participants aged 60-83 years who attended a study visit in 2005-2006 were included (n=1,069). Dietary intake was assessed with a 131-item Willett food frequency questionnaire. Adherence to healthy dietary patterns was assessed using a priori scores for DASH and aMED. We used Cox proportional hazards models to study the association between tertiles of healthy dietary patterns and all-cause mortality through December 31, 2019. Results: There were 452 deaths observed over a median follow-up of 13 years (12,564.3 person-years). Incidence rates were lower in the third tertile, indicating high adherence to healthy dietary patterns (DASH: 32.9 per 1,000 person-years; aMED: 28.5 per 1,000 person-years), compared to the first tertile (DASH: 39.6 per 1,000 person-years; aMED: 40.0 per 1,000 person-years). Participants in the third vs. first tertile for adherence to the DASH and aMED diets had a 22% and 37% lower risk of all-cause mortality, respectively [hazard ratio for DASH: 0.78 (95% CI, 0.62 - 0.98); aMED: 0.63 (95% CI, 0.49 - 0.83)] after adjusting for age, sex, race, study centers and total energy intake. An approximately linear, inverse relationship was observed between healthy dietary patterns and risk of all-cause mortality for both DASH and aMED ( Figure ). Conclusion: Higher adherence to healthy dietary patterns, specifically the DASH and aMED diets, is associated with lower risk of mortality among older adults. Following a healthy diet may improve survival in the aging population.
Abstract P258: Global Stress and Masked Hypertension in African-Americans: The Jackson Heart Study
Authors: Miriam A Miles, Oluwasegun P Akinyelure, Swati Sakhuja, Shakia T Hardy, Byron C Jaeger, Tanya M Spruill, Daichi Shimbo, Hiroyuki Mizuno, Mario Sims, Lenette M Jones, Paul Muntner
Journal: Circulation (2023)

Background: Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting. Methods: We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP &lt; 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use. Results: Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score &gt; 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table). Conclusion: No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.
Abstract P133: Deficient Screening for Cardiometabolic Risk Factors in a Central Appalachian Health System
Authors: Lee A Pyles, Christa Lilly, Paige Poffenberger, Rachel Kohler, William H Burton, Lesley A Cottrell, Eloise Elliott
Journal: Circulation (2023)

Problem: West Virginia perennially leads the US in child obesity and adult heart disease. We had screened over 100,000 school children for cardiometabolic risk factors (CMRF) in the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) program over 20 years until the 2017 economic downturn. 60,000 had lipid panels. WVU Health System includes encounters with over 200,000 WV children. We hypothesize that CMRF screening has decreased without the statewide CARDIAC Program. Methods: We queried our instance of Epic Electronic Health Record that includes much of northern WV to ascertain BMI, Total Cholesterol (TC) , Low Density Lipoprotein Cholesterol (LDL), triglyceride level (TG) and hemoglobin A1C. We also searched for use of cholesterol-lowering medicines. Results: 137,566 children under 18 years had a BMI measure and we have reported a 5%ile increase in the COVID era. Only 8498 have had a total cholesterol check (avg ± SD 159+34 mg/dl), 9964 had triglyceride (109 ± 74 mg/dl) and 4874 had LDL (92.04 ± 29.8 mg/dl). 2609 children had average HA1C 6.03 ± 1.7%. 607 children had LDL ≥ 130 mg/dl including 174 with LDL ≥ 160 mg/dl. 33 were given lipid-lowering medication and had LDL change from 248 ± 86 mg/dl to 181 ± 42 mg/dl at follow-up. Average decrease was 67 ± 79 mg/dl (p &lt; 0.0001). Conclusion: Few children are being screened for TC, LDL and TG absent the statewide CARDIAC lipid screening program in WV. Lipid-lowering medicines are sparsely used in children with significant risk of Familial Hypercholesterolemia (FH). Family history is not available for the cohort. None in FH range were below the 130 mg/dl LDL target value after treatment. In this pediatric population with usual incidence of FH and high prevalence of dyslipidemia of obesity with high BMI and TG levels, little lipid screening is occurring without the statewide school-based program. Child health care providers need to intervene to prevent even greater WV coronary disease in the future. Policy-makers can impact the future health of WV school children by promoting and funding screening for cardiometabolic risk factors now.
Abstract P373: Health Care Access and Usage Patterns Among Native Americans: The Strong Heart Study
Authors: Valarie Jernigan, Elisa T Lee, Jeunliang Yeh, Richard R Fabsitz, Barbara V Howard, Ying Zhang
Journal: Circulation (2023)

Introduction: Previous research has shown that health care access and usage patterns among Native Americans are often difficult to measure. Hypothesis: We hypothesize that sociodemographic factors such as age, gender, education, and employment influence health care access and usage patterns in Native communities in the Strong Heart Study (SHS). Methods: The SHS is a prospective population-based epidemiological study of cardiovascular disease and its associated risk factors in American Indians (AI). Between 1997 and 1999, surviving participants (N=2,382) of the original cohort were invited to a third exam, in which health care access and usage information were collected, along with other clinical and sociodemographic measurements. Multivariate logistic regression was used to find influencing factors of health care choices. Results: The majority of study participants (79%, 1,877/2,382) reported Indian Health Services (IHS) as their primary source of care, and close to one-third (29%, 689/2,358) reported having no additional coverage. Figure 1 showed travel time, waiting time after arriving at the clinics, and waiting time of a walk-in visit in IHS, tribal health service, and private practice. As participants aging or obtaining more years of education, they were less likely to use public (IHS or tribal) health service vs. private practice with odds ratio (95% confidence interval) 0.97 (0.95-0.99, p&lt;0.01) and 0.89 (0.84-0.93, p&lt;0.01) respectively, adjusting for gender and employment status. Conclusions: SHS participants primarily utilize IHS compared to other health services. Average waiting time is longer for IHS facilities (vs. private practice or tribal health facilities) with 35% (622/1,760) participants waiting for &gt; 60 minutes to be seen in regular appointments, and with 53% (814/1,540) participants waiting for &gt; 60 minutes in a walk-in visit. Age and education influence access to and selection of health care services for AI. This report provides baseline information for future health care access study in SHS.
Abstract 59: Social Determinants of Health and Incident Apparent Treatment Resistant Hypertension in a National Cohort of Black and White US Adults
Authors: Oluwasegun P Akinyelure, Byron C Jaeger, Suzanne Oparil, April P Carson, Monika M Safford, Lonnie Hannon, Andrew M Sims, George Howard, Paul Muntner, Shakia T Hardy
Journal: Circulation (2023)

Background: Identifying social determinants of health (SDOH) associated with incident apparent treatment resistant hypertension (aTRH) may guide interventions to reduce the incidence of aTRH and its associated cardiovascular disease risk. Methods: We analyzed data from 2,769 White and 2,254 Black US adults from the REasons for Geographic and Racial Differences in Stroke study taking antihypertensive medication with controlled blood pressure (BP) at baseline to estimate the association of SDOH with incident aTRH. SDOH were guided by the Healthy People 2030 domains of education, economic stability, social context, neighborhood environment and healthcare access. Incident aTRH was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg for those with diabetes or chronic kidney disease, while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication regardless of BP level, at a follow-up visit. Results: Over a median 9.5 years of follow-up, 16.1% of White versus 23.7% of Black adults developed aTRH. After age and sex adjustment, the SDOH associated with incident aTRH (hazard ratio; 95% CI) included having less than a high school education (1.51; 1.22 - 1.87), being a high school graduate (1.30; 1.10 - 1.53), and attending some college (1.29; 1.10 - 1.52) versus college graduate; annual household income &lt;$20,000 (1.83; 1.46 - 2.30), $20,000 to &lt;$35,000 (1.53; 1.23 - 1.90) and $35,000 to &lt;$75,000 (1.24; 1.00 - 1.53) versus ≥$75,000; having no one to care for you if ill (1.29; 1.08 - 1.55); living in a disadvantaged neighborhood in quartiles 1 (1.72; 1.42 - 2.08) and 2 (1.48; 1.22 - 1.80) versus 4, or a high poverty zip code (1.26; 1.09 - 1.47); not having health insurance (1.36; 1.06 - 1.74) and residing in a state with low public health infrastructure (1.17; 1.02 - 1.33). Results stratified by race are presented in the Table. Conclusion: SDOH were associated with transitioning from controlled BP to incident aTRH among White and Black adults.
Abstract P384: Gender Disparities in the Co-Existence of Hypertension and Diabetes in South Africa: Results From the Nationwide Demographic and Health Household Survey Data
Authors: Ngianga-Bakwin Kandala, Saverio Stranges
Journal: Circulation (2023)

Introduction: The rapidly growing public health burden of cardiovascular disease and diabetes in low- and middle-income countries threatens the progress expected by many countries’ effort to combat endemic infectious diseases and achieve good health and wellbeing (SDG3). Specifically, in South Africa the burden of hypertension and diabetes is a preventable but still neglected public health issue, causing a large number of premature deaths among men and women. There are very few population-based studies examining the distribution of risk factors and the combined burden of hypertension and diabetes prevalence in South Africa to inform an effective public health response. Objectives: This study investigates potential gender disparities in the co-existence of hypertension and diabetes prevalence and provincial variation in South Africa in 2016, adjusting for individual level demographic, behavioural and socio-economic variables, while allowing for spatial autocorrelation and adjusting simultaneously for the hierarchical data structure and risk factors. Methods: The study sample was based on participants aged ≥15 years from the 2016 South Africa DHS. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported health professional diagnosis or on antihypertensive medication and diabetes was defined as self-reported health professional diagnosis or on diabetic medication. Bayesian geo-additive regression modelling investigated the association of various socio-economic factors on the prevalence of both hypertension and diabetes across SA’s nine provinces while controlling for the latent effects of geographical location. Results: The prevalence of hypertension, diabetes, and combined hypertension and diabetes were 48.2% (4212 of 8679), 4.5% (458 of 10255) and 3.8% (314 of 8195) successively in the DHS in 2016. The prevalence of hypertension increased with age and was significantly higher in male, in people of coloured ethnic group, in overweight and obese, in people with high blood cholesterol and varied with geographical location. Diabetes prevalence increased with age and was significantly higher in male, in overweight and obese and in people with high blood cholesterol. The co-existence of the prevalence of both combined hypertension and diabetes was significantly higher in male, in overweight and obese and in people with high blood cholesterol, in people with heart attack/angina and increased with age. Conclusions: The findings can inform public health policy and decision making regarding the allocation of public resources to tackle the growing burden of hypertension and diabetes in South Africa, particularly in the most affected areas and subgroups of the population. Public health education aiming at the prevention of CVDs should target both ailments at the same time as cost-effective measure to achieve SDG3.